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Hypocalcemia Surveillance, Total Thyroidectomy — Symptoms of Hypo/Hypercalcemia & Recommended Treatment — Clinical Pathway: Inpatient and Outpatient Specialty Care

Thyroidectomy Calcium Management Clinical Pathway — Inpatient and Outpatient Specialty Care

Symptoms of Hypo/Hypercalcemia & Recommended Treatment

Treatment of Symptomatic HYPOCALCEMIA with IV Calcium
IV Calcium
    • Initial Dose
    • Give 1 dose of calcium gluconate 100 mg/kg/dose (maximum of 3000 mg/dose)
    • Administer via slow IV infusion (NOT a bolus) over 4 hours
    • Monitor patient on telemetry in the PICU
    • Use a central or large peripheral IV line
    • Ensure IV calcium is infused only through large veins; avoid hand, foot, and/or scalp veins
      • Calcium causes severe scarring if extravasation occurs
    • Considerations for repeat IV calcium dose
    • Continued symptoms and/or corrected calcium remains < 7 mg/dL
    • If multiple repeat doses required – consider placing patient on a continuous IV calcium infusion
Monitoring
  • Repeat calcium measurement 2 hours after completion of the calcium gluconate infusion, monitor closely until stable calcium is achieved
PO Calcium
  • Begin oral calcium while calcium gluconate is infusing
PO Calcitriol
  • Begin oral calcitriol if not already initiated

 

Signs and Symptoms of HYPOCALCEMIA
Symptoms
  • Perioral numbness
  • Tingling of the hands or feet
  • Anxiety, depression
  • Fatigue
Signs
  • Hypotension
  • Tetany
  • Muscle cramps and/or spasms (especially during measurement of blood pressure)
  • Papilledema
  • Stridor
  • Laryngospasm (dysphagia or change in voice)
  • Focal or generalized seizures
  • Prolonged QT or QTc on EKG
  • Trousseau’s sign
    • Induction of carpopedal spasm by inflation of a sphygmomanometer above systolic blood pressure for 3 minutes
  • Chvostek’s sign
    • Contraction of ipsilateral facial muscles elicited by tapping facial nerve anterior to ear;
    • Note: occurs in ~10% of normal individuals

 

Signs and Symptoms of Acute HYPERCALCEMIA Treatment of Symptomatic HYPERCALCEMIA
  • Gastrointestinal
    • Anorexia, nausea, vomiting, constipation
  • Renal
    • Polyuria, polydipsia, renal insufficiency
  • Musculoskeletal
    • Muscle weakness, bone pain
  • Neurologic
    • Confusion, fatigue, stupor, coma
  • Cardiovascular
    • Shortened QT interval, bradycardia, hypertension
  • Notify Endocrine team on call of hypercalcemia
  • Start calcium-free IV fluids
  • Discontinue calcium carbonate and calcitriol pending improvement

 

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